POS0077-HPR ENHANCING CURRENT GUIDANCE FOR PSORIATIC ARTHRITIS AND ITS COMORBIDITIES: RECOMMENDATIONS FROM AN EXPERT CONSENSUS PANEL OF HEALTHCARE PROFESSIONALS IN THE UK
Authors: L. Coates, M. Bukhari, A. Chan, E. Choy, J. Galloway, N. Gullick, A. Kent, L. Savage, S. Siebert, W. Tillett, N. Wood, P. G. Conaghan
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psoriatic arthritis (PsA) is a chronic inflammatory arthritis occurring in 20–30% of patients with psoriasis.<sup>[1]</sup> Timely diagnosis is important because untreated PsA can lead to irreversible joint damage<sup>[1]</sup> and functional disability.<sup>[2]</sup> While existing national and international guidelines, such as those provided by EULAR, BSR, ACR/National Psoriasis Foundation and GRAPPA, cover a wide range of aspects of diagnosis and pharmacological management of PsA, gaps have been identified relating to the application of guidance in clinical practice, ongoing non-pharmacological management, and quality of care benchmarking, often related to a lack of evidence. In response, an expert UK consensus group aimed to enhance current guidance. <h3>Objectives</h3> To develop an evidence- and consensus-based set of recommendations for the management of PsA in routine clinical practice that adds value to existing guidelines, suggests minimum and best quality standards for day-to-day PsA management and provides a set of practical strategies to achieve these quality standards, with the aim of supporting clinicians. <h3>Methods</h3> A steering committee (SC) was formed of 12 experts in the fields of rheumatology, dermatology and primary care. At an initial meeting, consensus themes were discussed and agreed (PsA diagnosis, disease assessment, comorbidities, and management) and consensus questions were drafted. A targeted literature review of PubMed and Embase following a PICO framework was conducted to gather scientific evidence supporting a selection of the questions, while others were agreed to be more appropriate to answer using expert clinical experience. At a second meeting, recommendations were drafted in response to the identified questions, covering gaps in current guidelines. For the next stage, an extended faculty was recruited including rheumatologists (32), dermatologists (6), primary care representatives (3), specialist nurses (5), academics (12) and members of the Brit-PACT patient group [6]. In an online voting platform, the SC and extended faculty entered an agreement score for each recommendation. Consensus was achieved when 75% of respondents agreed in the range of 7–9 on a 9-point scale. <h3>Results</h3> The SC and extended faculty agreed on 34 statements covering 15 questions on PsA diagnosis, disease assessment, comorbidities, and management. The diagnosis theme focussed on strategies to identify PsA early and refer appropriately, the assessment of diagnostic indicators, and guidance on the use of screening tools. The use of imaging to support diagnosis, and appropriate referral time frames were also covered in detail. Recommendations on disease assessment centred on holistic consideration of disease activity, functional impairment and impact from a patient perspective, as well as how to implement shared decision-making. Specific guidance for measurements to be performed at clinic visits was included. For comorbidities, recommendations were made for assessment and management, with specific guidance for high-impact conditions, such as depression and obesity, and those with implications for PsA pharmacological therapy. Management statements (which excluded guidance on pharmacological therapies in extant guidelines) covered multidisciplinary team working, implementation of lifestyle modifications, and treat-to-target strategies built upon the parameters of greatest importance to individual patients. The use of corticosteroids was recommended to be minimised where feasible. <h3>Conclusion</h3> This expert consensus programme identified critical areas beyond pharmacological therapy where existing guidance on PsA management could be enhanced and be of greater practical relevance to clinicians. This work will also be developed into a clinical resource to support healthcare professionals in the care of patients with PsA. <h3>References</h3> [1]Mulder M et al. Arthritis Res Ther. 2021;23(1):168 [2]Haroon M et al. Ann Rheum Dis. 2015;74(6):1045–50 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Laura Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, UCB, Marwan Bukhari Speakers bureau: Jannssen, AbbVie, Merck, Galapagos, Eli Lilly, Consultant of: Janssen, Antoni Chan Speakers bureau: Amgen, Celgene, Novartis, Pfizer, Consultant of: Janssen, Grant/research support from: UCB, Ernest Choy Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Boehringer Ingelheim, Chugai Pharma, Eli Lilly, Fresenius Kai, Galapagos, Gilead, Hospira, MSD, Novartis, Pfizer, Regeneron, Roche, Sanofi-Aventis, UCB, Consultant of: AbbVie, Amgen, Biogen, Chugai Pharma, Eli Lilly, Fresenius Kai, Gilead, Janssen, Pfizer, Regeneron, Roche, Sanofi-Genzyme, Grant/research support from: Bio-Cancer, Biogen, Pfizer, Sanofi, James Galloway Speakers bureau: AbbVie, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche, UCB, Consultant of: AbbVie, Galapagos, Lilly, Janssen, Pfizer, Grant/research support from: GSK, Pfizer, Nicola Gullick Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, Janssen, Novartis, UCB, Grant/research support from: AbbVie, AstraZeneca, Eli Lilly, Novartis, Alison Kent Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Merck-Sharp &amp; Dohme, Novartis, Pfizer, Sanofi Genzyme, Regeneron, UCB, Consultant of: AbbVie, Amgen, Bristol Myers Squibb, Janssen, Merck-Sharp &amp; Dohme, Novartis, Pfizer, Sanofi Genzyme, UCB, Laura Savage Speakers bureau: AbbVie, Amgen, Almirall, Celgene, Celltrion, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer, MSD and UCB, Consultant of: AbbVie, Almirall, Biogen, Eli Lilly, Galderma, Janssen-Cilag, Leo, Novartis, Pfizer and UCB, Grant/research support from: Pfizer, Stefan Siebert Speakers bureau: AbbVie, GSK, Janssen, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Eli Lilly, Janssen, UCB, Grant/research support from: Institutional research support from Amgen (previously Celgene), Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, GSK, Janssen, UCB, William Tillett Speakers bureau: AbbVie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Eli Lilly, GSK, Janssen, Novartis, Ono Pharma, Pfizer, UCB, Grant/research support from: Eli Lilly, Janssen, Pfizer, UCB, Natasha Wood Consultant of: Janssen, Philip G Conaghan Speakers bureau: AbbVie, Novartis, Consultant of: AstraZeneca, Biosplice, Bristol Myers Squibb, Eli Lilly, Galapagos, Genascence, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Stryker, UCB.